Post-Laparoscopic Cholecystectomy Pain: Effects of Preincisional Infiltration and Intraperitoneal Levobupivacaine 0.25% on Pain Control-a Randomized Prospective Double-Blinded Placebo-Controlled Trial.

OBJECTIVE: The aim of this study was to compare the postoperative analgesic efficacy of preincisional and intraperitoneal levobupivacaine or normal saline in patients undergoing laparoscopic cholecystectomy. METHODS: Sixty patients who participated in the study were randomly divided into 3 groups. Group 1 received intraperitoneal levobupivacaine (0.25% 40 mL) immediately after the pneumoperitoneum. Group 2 received periportal levobupivacaine (0.25% 5 mL in each trochar incision area) before incision and intraperitoneal levobupivacaine (0.25% 40 mL) immediately after the pneumoperitoneum. Group 3 received for periportal and intraperitoneal instillation of normal saline. The visual analog scale (VAS) at 0, 1, 2, 4, 8, 12 and 24 hours for both shoulder and abdominal pain were recorded. Analgesia requirements and incidence of nausea and vomiting were also recorded. RESULTS: There were no difference between the groups for demographic data. The pain scores were lower in Groups 1 and 2 than Group 3 (control) during rest, cough and movement (p<0.05). Rescue analgesic treatment was significantly lower in patients of Group 2 (15%) as compared with that of Groups 1 (35%) and 3 (90%) (p<0.05). The incidence of shoulder pain was significantly lower in Group 2 (25%) and Group 1 (20%) than in any of the control group patients (p<0.05). CONCLUSION: The results indicated that 0.25% levobupivacaine was effective in preventing pain and the need for postoperative analgesic when intraperitoneal instillation or preincisional local infiltration in combination with intraperitoneal instillation. However, levobupivacaine for preincisional local infiltration in combination with intraperitoneal instillation is the better choice because of its higher efficacy.

The evaluation of gallstone formation in patients undergoing Roux-en-Y gastric bypass due to morbid obesity.

OBJECTIVE: This study aimed to evaluate gallstone formation, prophylactic and selective cholecystectomy and the effectiveness of ursodeoxycholic acid treatment following laparoscopic Roux-en-Y gastric bypass (LRYGB) in morbid obese patients. MATERIAL AND METHODS: Files of 60 patients who underwent LRYGB between October 2006 and March 2011 were retrospectively reviewed. Patients were evaluated for formation of gallstones. RESULTS: Fifty-three (88.3%) patients were female and seven (11.7%) were male. Eight of the 60 patients (13.3%) had previously undergone cholecystectomy. Six patients (11.5%) underwent cholecystectomy in addition to LRYGB due to preoperatively detected gallstones by ultrasonography. The remaining 46 patients were followed up for a mean duration of 28.57 months (5-56 months). In 10 (21.7%) of these patients, gallstones were detected and five patients with symptomatic gallstones underwent cholecystectomy. Patients who did and did not develop gallstones after LRYGB did not show a significant difference regarding age, gender and the new body mass index (BMI). Three patients were started on ursodeoxycholic acid and the treatment was continued for six months. Gallstones were not detected in these patients. CONCLUSION: In light of these data, since only a very small portion of patients develops symptomatic gallstones after LRYGB, we recommend cholecystectomy in patients with symptomatic gallstones or the use of ursodeoxycholic acid rather than a prophylactic approach. Prospective randomized controlled studies in larger series are required to support these results.

Effective weight control and normalization of metabolic parameters after laparoscopic sleeve gastrectomy: a single center experience.

BACKGROUND/AIMS: Obesity is one of the most serious public health problems. Laparoscopic sleeve gastrectomy (LSG), a type of bariatric surgery, is emerging as the new promising therapy for the treatment of morbid obesity. METHODOLOGY: In the present study we aimed to assess the effects of LSG on body weight and other obesity related pathological conditions. RESULTS: A total of 19 obese subjects underwent LSG surgery. All patients underwent complete evaluation including anthropometric/clinical parameters and laboratory tests. Hypertension (HT), diabetes mellitus (DM), body mass index (BMI), and hyperlipidemia were significantly reduced after LSG. CONCLUSIONS: Results of this study demonstrate that LSG induces stable weight loss and resolution of obesity-associated comorbidities.

Diagnostic value of ultrasonography in appendicitis.

BACKGROUND: Clinical diagnosis of appendicitis is often difficult in atypical patients. OBJECTIVES: The authors aim to determine the diagnostic accuracy of ultrasonography (US) for acute appendicitis. MATERIAL AND METHODS: 121 consecutive patients with right lower abdomen pain were evaluated. Of them, 25 were excluded due to not having performed a preoperative US and 5 were obese (Body Mass Index > 30). A total of 91 patients were evaluated. The patients were assessed clinically and radiologically. Blood and urine analysis was carried out in all patients. US was performed with a Toshiba Fomio 8 brand machine with 3.75 and 8 MHz linear probes. Patients underwent an operation and an appendicectomy was done. Specimens were sent for histopathology to confirm appendicitis. RESULTS: Ultrasound supported the diagnosis of acute appendicitis in 58 (63.7%) patients. In the US with positive findings, 55 patients (94.8%) had inflamed appendices on histopathology and 5 (8.6%) had normal appendices. The overall sensitivity of ultrasonography was 71.4% and specificity was 78.5%. Positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy of ultrasonography are 94.8%, 33.3%, and 72.5% respectively. CONCLUSIONS: All diagnostic tests are adjunctive to the clinician. US should be the first step in the care of patients with right lower abdominal pain after the physical examination.

Laparoscopic resection of retroperitoneal schwannoma near the inferior vena.

BACKGROUND: Schwannomas are usually benign tumors that arise from the schwann cells in the neural sheaths of peripheral nerves. Most schwannomas occur in the head, neck, or limbs and rarely in the retroperitoneal space. In the retroperitoneal space, schwannomas are most commonly located near the adrenal gland. We report a successfully resected retroperitoneal benign schwannoma near the inferior vena cava (IVC) using laparoscopic surgery. METHODS/RESULTS: A 33-year-old woman presented with dull abdominal pain for several months. Magnetic resonance imaging confirmed the existence of a round, sharply demarcated retroperitoneal solid tumor, 42 x 52 mm in size, located between the anterior of the right kidney and the IVC, which was compressed but still patent. The lesion was laparoscopically resected, and pathologic examination revealed a degenerative schwannoma. CONCLUSION: Laparoscopic surgery is very useful and feasible in the diagnosis and treatment of retroperitoneal schwannoma, with minimal invasiveness and early postoperative recovery.